Hospital vs. Workers’ Compensation Interpreter?

Most people reading this title would probably be somewhat perplexed. Aren’t hospital and workers’ compensation interpreters both healthcare interpreters under the same code of ethics?

The answer to that question is yes!

If that is the case, then why would an opposing distinction be made between them? Shouldn’t there be a collaborative spirit among professionals?

Again, yes there should be a cooperative disposition. However, there are subtle differences between hospital interpreters and worker’s compensation interpreters. These distinctions can at times result in challenges that should be overcome.

Hospital Interpreter:

Typically hired, tested, trained and continuing education conducted by the hospital. They must follow not only the medical interpreter Code of Ethics, but also hospital procedures.

Workers’ Comp. Interpreter:

Hired by insurance company, typically, though not necessarily, subcontracted through a language agency. Language agencies usually subcontract individual entrepreneurs who are responsible for their own continuing education and training. This unregulated process often results in a large list of common problems. (SOAP: Subject of Another Post.)

Hospital Setting:

By its nature, healthcare settings can be emotionally charged. The emergency room is the most challenging of circumstances, often because a person’s life hangs in the balance. However, anyone entering a medical center for any procedure is usually very nervous. Moreover, concerned family members who accompany the patient add to the stress. Hospital interpreters are normal people with feelings and can easily empathize with a suffering patient and his family. Such empathy in a very stressful setting can lead the hospital interpreter to lose his or her unbiased professionalism and react emotionally. This emotional reaction might make the patient and his family feel like someone is on their side, but it does them no good if the interpreter, while emotional, does not think or interpret rationally.

For this reason, many hospital procedures limit the interpreter’s personal exposure to patients. Instead of remaining in the room with the patient and becoming familiar, possibly leading to emotional compromise, hospital policy deters that very situation.

When a doctor, nurse or other healthcare professional enters the room, the hospital interpreter enters with them and performs his duties. When they leave, the interpreter leaves with them and waits outside until the next healthcare professional enters the room.

As mentioned earlier, workers’ compensation carriers often contract language agencies who then subcontract the interpreting assignment to local individuals.

Normally, an interpreter is assigned to a claimant (also known as the patient and injured worker) once a case opens. The interpreter will accompany the injured worker to all medical appointments to provide professional language services until the case settled. These include, but are not limited to doctor visits, physical therapy appointments, X-rays, imaging appointments, nerve conduction tests, and any procedures or surgeries.

In many cases, though not all, the same interpreter also provides transport for the patient. The insurance company can often secure cost savings when the interpreter both transports and interprets for the injured worker.

This setting, by its nature, creates a conundrum for professional healthcare interpreters whose ethics bind them to stay unbiased. The worker’s compensation interpreter is not bound by hospital protocol to leave the room and only enter when interpreting is required. This means that the interpreter and patient spend a lot of time together. They become well acquainted over many months, sometimes years. In fact, the patient grows to see the interpreter as his close friend and confidant. This perceived relationship makes it pose an issue for the worker’s compensation interpreter to maintain professionalism.

Now, imagine this. Instead of hiring a professional or certified interpreter familiar with and cognizant of the Code of Ethics, an untrained bilingual person is hired to simply cover the assignment. Without proper knowledge and training, the bilingual person serving as an interpreter will most likely unconsciously commit serious ethical violations, while at the same time believing a good deed was done. (SOAP)

Creating the Problem:

Picture an insecure, nervous patient entering the medical center and meeting for the first time an interpreter. Her vocabulary and accent are a little different from what the patient is accustomed to hearing. The patient is having trouble understanding everything, thereby increasing patient’s anxiety. By his side is his trusted workers’ comp interpreter. The patient has known this professional for many months and clearly understands the interpretation. He feels comforted by his usual interpreter’s presence because of established trust.

By policy, the hospital must have its interpreter present to assure quality and avoid liability. (SOAP) Additionally, the patient complains that he doesn’t understand the hospital’s interpreter. For this reason, the insurance carrier assigns its interpreter to ensure that the patient comprehends everything and can make informed decisions.

When the two worlds collide:

The extremely worried patient now requests that his workers’ comp interpreter take the lead to ensure his understanding. Below are the reactions I have encountered:

The hospital interpreter states that per hospital policy she must interpret and removes the workers’ comp interpreter. (SOAP)

The hospital interpreter states that she must interpret but the workers’ comp interpreter can stay and clarify. (SOAP)

The hospital interpreter explains that she must stay to assure accuracy but that the workers’ comp interpreter may take the lead. (SOAP)

This unprofessional reaction I have heard about but we avoid:

The hospital interpreter explains that the workers’ comp interpreter cannot interpret, and the workers’ comp interpreter begins to argue and make a scene.

As you can see by my SOAP notations, there will be future articles relating to separate aspects of this post. The first and last scenario have led to patients having panic attacks and canceled or delayed procedures, not to mention distrust. What is important to recognize is that the patient needing an interpreter should feel at ease while receiving proper professional service. The two middle options generally have resulted in successful collaboration.